Biomedical subjects
B Skinner
Publications and source records attributed to B Skinner.
What works: financial application. One system fits all.
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The high prevalence of sexual concerns among women seeking routine gynecological care.
BACKGROUND: Sexuality is an important part of health, quality of life, and general wellbeing. Studies indicate that less than half of patients' sexual concerns are known by their physicians, and physicians are unaware of how common these sexual concerns are in their practices. Our objective was to determine the prevalence and type of sexual concerns among women seeking routine gynecological care. METHODS: We mailed the survey in waves. Of 1480 women seeking routine gynecological care from the departments of Family Practice and Obstetrics and Gynecology at Madigan Army Medical Center between August 1992 and January 1993, 964 responded. The main outcome measures were self-reported sexual concerns and their experiences with discussing these concerns with a physician. RESULTS: A A total of 98.8% of the women we surveyed reported one or more sexual concerns. The most frequently reported concerns were lack of interest (87.2%), difficulty with orgasm (83.3%), inadequate lubrication (74.7%), dyspareunia (71.7%), body image concerns (68.5%), unmet sexual needs (67.2%), and needing information about sexual issues (63.4%). More than half reported concerns about physical or sexual abuse, and more than 40% reported sexual coercion at some point in their lives. CONCLUSIONS: Our results suggest that sexual health concerns are prevalent for women seeking routine gynecological care. Sexual health inquiry should be a regular and important part of health care maintenance.
Some responses to the stimulus "pavlov." (reprinted).
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Regulation of pyelonephritis-associated pili phase-variation in Escherichia coli: binding of the PapI and the Lrp regulatory proteins is controlled by DNA methylation.
Expression of pyelonephritis-associated pili (Pap) in Escherichia coli is under a phase-variation control mechanism in which individual cells alternate between pili+ (ON) and pili- (OFF) states through a process involving DNA methylation by deoxyadenosine methylase (Dam). Methylation of two GATC sites (GATC1028 and GATC1130) within the pap regulatory region is differentially inhibited in phase ON and phase OFF cells. The GATC1028 site of phase ON cells is non-methylated and the GATC1130 site is fully methylated. Conversely, in phase OFF cells the GATC1028 site is fully methylated whereas the GATC1130 site is non-methylated. Two transcriptional activators, PapI and Lrp (leucine-responsive regulatory protein), are required for this specific methylation inhibition. DNA footprint analysis using non-methylated pap DNAs indicates that Lrp binds to a region surrounding the GATC1130 site, whereas PapI does not appear to bind to pap regulatory DNA. However, addition of Lrp and PapI together results in an additional DNaseI footprint around the GATC1028 site. Moreover, Dam methylation inhibits binding of Lrp/PapI near the GATC1028 site and alters binding of Lrp at the GATC1130 site. Our results support a model in which Dam and Lrp/PapI compete for binding near the GATC1028 site, regulating the methylation state of this GATC site and, consequently, the pap transcription state.
Papanicolaou smear quality assurance: providing feedback to physicians.
BACKGROUND: The effective management of Papanicolaou (Pap) smears depends on the reliability and accuracy of obtaining and interpreting the specimen. Provider sampling error is one of the important factors contributing to inadequate specimens. Feedback on provider performance may be an effective way to improve the quality of Pap smears. METHODS: A pilot study in a university-based residency program involving resident and faculty physicians was initiated to assess the impact of feedback on performance of Pap smears. After establishing adequacy and inadequacy criteria and recording adequacy rates for 3 months, individual and group feedback was implemented. No formal educational intervention on Pap smear technique was undertaken. RESULTS: The quality of 836 Pap smears performed by 9 faculty and 13 resident physicians showed continued improvement in both sampling and slide preparation to 90% adequacy over a 9-month period. This improvement, though clinically useful, was not statistically significant owing to the relatively small numbers of smears performed by each physician. This form of feedback may be useful in both practice and educational settings. CONCLUSIONS: Feedback without any formal educational intervention led to a clinically useful trend of improvement in the quality of Pap smears, which has been sustained since the study began. This type of simple feedback may be useful in practice settings and particularly valuable in pinpointing areas for improvement for learners in residency programs.
Development of a Pap smear quality-assurance system in family practice.
BACKGROUND AND OBJECTIVES: To improve the effectiveness of cervical cancer screening, quality assurance programs can be designed to ensure that normal Pap smear results are dealt with appropriately and that Pap smears yielding inadequate specimen material are brought to a physician's attention. The objective of this study was to use a new Pap Smear Quality Assurance (PAPQA) system to determine and monitor the performance of physicians in a family practice over a two-year period. METHODS: We developed a PAPQA system designed to gather data and report on: 1) Pap smear adequacy, 2) reporting of abnormal results to physicians, and 3) follow-up of patients who had abnormal Pap smear results. We followed these parameters for two years. RESULTS: Over a two-year period, 2,771 cervical Pap smears were performed, of which 64% were normal. The percentage of Pap smears that yielded adequate specimen material improved from 82% to 91%, an improvement we attributed to feedback the system provided to physicians. Overall, Pap smear results and follow-up appeared in the medical record of 94% of patients who had abnormal findings. However, during the second year, the quality assurance system detected a deterioration in documentation of results and follow-up plans that coincided with moving the practice to a new facility. The operating cost for this program was approximately $950 per year. CONCLUSIONS: Quality assurance programs can effectively monitor physicians' performance in dealing with abnormal Pap smears, can detect deteriorations in performance, and can improve some aspects of performance through feedback reporting to physicians.
How to participate in your own health: a cancer patient's view.
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Inside the chart review.
The study on which this article is based was conducted at the University of North Carolina's Family Practice Center to analyze the content of teaching that occurred in the face-to-face chart review sessions. Data were collected from a sample of 276 chart reviews and processed by a microcomputer program that compiled reports of types of problems encountered by residents, topics of discussion pertinent to those problems, and learning needs defined as a result of those discussions. Reports were generated for faculty members nad residents, and summary reports were produced for the teaching encounters. This system of computerized data analysis can be used to identifying learning needs of residents and areas of teaching emphasis for faculty. The information can be used for educational planning and faculty development.
Observations on Tc-99m-erythrocyte venography in normal subjects and in patients with deep vein thrombosis.
Blood pool imaging of the lower limbs with Tc-99m-erythrocytes demonstrates the deep venous channels of the leg. The radionuclide image of deep vein thrombosis, by this method, appears sufficiently distinctive to suggest that Tc-99m-erythrocyte venography may be a useful screening examination for deep vein patency.
Association of coronary atherosclerosis with hyperapobetalipoproteinemia [increased protein but normal cholesterol levels in human plasma low density (beta) lipoproteins].
Most patients with coronary artery disease do not have elevated plasma or low density lipoprotein (LDL) cholesterol. To test whether the protein moiety of LDL, LDL B, might be a parameter to identify ischemic heart disease, the plasma cholesterol, triglyceride, LDL cholesterol, and LDL B were measured in 100 consecutive patients undergoing cardiac catheterization. On the basis of coronary angiography, these patients were divided into two groups: group I, 31 patients without, and group II, 59 patients with significant coronary artery disease. Although cholesterol, triglyceride, and LDL cholesterol levels were all significantly higher in group II, discriminant analysis indicated that LDL B concentrations most clearly separated the two groups. In group I (noncoronary), LDL B was 82 +/- 22 mg/100 ml, whereas in group II, LDL B was 118 +/- 22 mg/100 ml. The B protein level in group I was similar to other normal groups studied (35 asymptomatic male physicians, 83 +/- 11 mg/100 ml; 90 normolipidemic medical students, 72 +/- 17 mg/100 ml). The results therefore indicate that not only does LDL B better separate coronary and noncoronary groups than other lipid parameters studied, but also, among those with coronary artery disease, there exists a group with normal LDL cholesterol but with levels of LDL B protein similar to those observed in type II hyperlipoproteinemia. The explanation for the altered LDL composition observed in this group remains to be elucidated.
Systemic lupus erythematosus: association with psoralen--ultraviolet-A treatment of psoriasis.
Systemic lupus erythematosus (SLE) developed in as 23-year-old woman with psoriasis during treatment with psoralen-ultraviolet-A (PUVA). The connective tissue disease was characterized by an erythematous rash, hair loss, nephritis, splenomegaly, seizures, and coma. Serum antinuclear antibodies were present in high titer, and hypocomplementemia developed. Antibodies to native or ultraviolet-irradiated DNA were not demonstrated. While the association of psoriasis and lupus may have been fortuitous, the temporal relationships suggest that PUVA treatment in this case may have been of pathogenetic importance in the development of the connective tissue disease.
Impedance phlebography: accuracy of diagnosis in deep vein thrombosis.
In an evaluation of the diagnostic accuracy of impedance phlebography for the diagnosis of deep vein thrombosis, 51 limbs in 32 patients were examined simultaneously by impedance phlebography and by venography. The impendance diagnosis and accurate in 47 limbs, erroneous in 2 and inconclusive in 2; the overall accuracy was 92%. Simultaneous clinical diagnosis yielded an accuracy of 53%. The method requires full cooperation by the patient and meticulous attention to the details of the test by the physician or technician performing the examination.
An unusual case of respiratory obstruction.
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The use of cinefluorography in peripheral arteriography.
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Changing the guard: how the Mewburn Veterans Centre received new owners.
The consolidation of programs and services is currently of great interest in Canadian health care. This article describes the process that was used to transfer a 146-bed continuing care centre from one hospital organization to another. Leadership, team work, structure and communication were found to be the keys to success in dealing with the many problems and complexities of a facility transfer.
Validating audiovisual reviews as a strategy for teaching behavioral medicine to primary care residents.
A study examining the usefulness of audiovisual reviews (AVR's) as a method of teaching behavioral medicine was done with family medicine residents and faculty at the UNC School of Medicine. A set of educational goals for family medicine residency training was established. In a survey faculty and residents were asked to rate the importance of teaching each goal during residency and the appropriateness of AVR's for teaching it. Observers recorded the content of discussion in 18 regularly scheduled AVR's. In survey results both faculty and residents agreed that AVR's are best suited for teaching behavioral medicine skills. However, there were different goals, depending on level of training. Content analysis of the observed AVR's showed that the four most valued teaching goals comprised 50% of the topics discussed in actual AVR's. Results of this study validate the use of AVR's as a teaching strategy for behavioral medicine skills.